Having persistent pain in your knees?  Trouble going up and down stairs? Do you feel you could do more in your workout if your knees weren’t so sore?  Do you want to stay involved with your active social group but finding it harder and harder?  If so, there is a conservative treatment plan that would work for you as long as the components of the plan are systematically applied and evaluated. 

There are 3 main reasons knees hurt.  First, the knee has become unstable due to tearing of a ligament in the knee, secondly the kneecap (patella) is not tracking properly and third from osteoarthritis.  Torn ACL’s (anterior cruciate ligaments) are the most common form of ligament instabilities usually due to sport or motor vehicle accidents.  These injuries are usually short termed as most individuals with torn ACL’s elect to have surgery to repair the ligament, wear a brace for 4 to 6 months while strengthening the quadriceps and then resume full involvement in their day to day activities. 

Patella femoral problems can persist for quite some time if not attended to effectively. Strengthening of the quads, wearing a patellafemoral knee brace, orthotics and appropriate footwear, correct physiotherapy treatments and “growing” out of the situation, are the usual protocols employed to deal with this problem.  Osteoarthritis (O/A) of the knee (usually involving the inside of the knee or the medial aspect) however is a degenerative disease that slowly causes the knee to become unstable, painful and have chronic swelling. This is cause by the wearing away of the cartilage of the knee and terms like “bone on bone” are used to indicate the severity of the problem. Radical treatments involve total knee replacements, replacing only the medial aspect of the worn out knee, or attempting to regenerate cartilage growth through cartilage plug implants.

Most physicians and their patients though would like to exhaust all conservative treatment options before having to explore surgery due to osteoarthritis of the knee. This is extremely important if the individual is young, usually under 65!  Conservative treatment for the arthritic knee can include:
physiotherapy treatments (range of motion exercises, strengthening, pain management techniques, etc) all based on a recent lower extremity evaluation,

•  knee bracing,
• use of orthotics and  correct footwear,
• medication,
• weight loss and/or maintenance,
• cold therapy
• age and ability appropriate activity choices which must include some form of strength training.     
  

Knee bracing for the arthritic knee has been shown to be an effective part of the conservative treatment protocal.  Fitted correctly and with the appropriate knee brace based on your level of function and body type, an O/A brace will help stabilize the knee and in most cases significantly reduce pain.  This is achieved by providing structural support on the outside of the knee to limit the side to side movement (varus/valgus thrust) and the front and back movement (translation) . In addition to providing stability, medial unloader O/A knee braces provide an external force on the outside of the knee to help reduce load and pressure on the inside of the knee. Factors affecting the success of an O/A knee brace include the severity of O/A, the angle of your knee (knockkneed vs bow legged), amount of instability, body weight, how the brace is fitted and maintained, length of time needed to wear the brace, the activities needed to perform, the overall strength of your leg muscles and your general fitness level.

In addition to increased stability and less pain of the knee, other benefits of wearing a knee braces includes a reduction in chronic swelling, less oral medication required, improved functional movement of the knee, increased confidence in performing day to day tasks, and enhanced safety. 

How do you know if a knee brace will help you?  First, consult with your Doctor as to why your knee(s) may be sore.In addition to a current medical exam, Xrays, MRI’s or bone scans will give further information to assess the problem. Second, obtain a full lower extremity physiotherapy evaluation which will determine muscular strength, strength imbalances, etc and get you on a program that is correct for YOU. Third, based on your physicians findings and/or the advise of the physiotherapist, explore the use of an appropriate knee brace.  Educate yourself about the styles available, the price (most insurance companies pay 80%), when you need to wear them, who is fiiting you and the follow up care provided.  Fourth, incorporate the advice and the plan of your physician, physiotherapist and brace fitter into your Nubody’s workout routine.  Usually only small adjustments will be needed to your workout plan to keep you active and a regular participant in your routine.

Try bracing for that old knee………….it works!

Written By:
Sandy Houston, BPE, MSc. (Kinesiology)
Orthopedic Bracing Specialist, Orthotrends